From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110.
Radiology. 2014 Oct;273(1):261-7. doi: 10.1148/radiol.14131664. Epub 2014 Jun 13.
To evaluate the feasibility of use and safety of a targeted radiofrequency ablation (RFA) device for metastatic posterior vertebral body tumors.
This retrospective study was institutional review board approved and HIPAA compliant. Consent was waived for retrospective participation. Fluoroscopic or computed tomography-guided targeted RFA was performed in 26 patients (47 tumors) with painful metastatic posterior vertebral body tumors, some of which were radiation therapy resistant, by using a newly developed spinal tumor ablation system that contains an articulating bipolar extensible electrode. In 14 women and 12 men aged 44-85 years (mean age, 62 years), the most common primary tumor was lung cancer in seven patients (27%) and renal cell carcinoma and sarcoma in five patients each (19%). Other tumors included breast cancer and melanoma in two patients each (8%) and colon cancer, multiple myeloma, neuroendocrine tumor, head and neck squamous cell carcinoma, and unknown primary tumor in one patient each (4%). Ablation was performed with device thermocouples that permitted real-time monitoring of the periphery of the ablation zones to determine ablation size. Sequential postprocedural pain scores were obtained. Thirteen patients underwent follow-up imaging, and one underwent subsequent biopsy of a treated area. A paired two-tailed Student t test was used to evaluate significance of postoperative visual analog scale scores of pain at 1 week and 1 month.
Four of 26 patients developed transient radicular symptoms after ablation, which resolved with transforaminal blocks. No permanent neurologic injuries resulted from the procedure. Intraprocedural imaging demonstrated that the articulating bipolar instrument could be navigated into the posterior vertebral body tumors with a transpedicular approach. Postablation imaging confirmed necrosis within the ablation zone. Three patients showed progression of disease at the treated levels at follow-up. Systemic therapy was not interrupted to perform the procedures.
Targeted RFA with a newly developed articulating device is both feasible and safe for the treatment of painful posterior vertebral body metastatic tumors.
评估一种靶向射频消融（RFA）设备用于治疗转移性后脊椎体肿瘤的可行性和安全性。
本回顾性研究经机构审查委员会批准并符合 HIPAA 规定。由于是回顾性参与，因此免除了患者的知情同意。在 26 名（47 个肿瘤）患有疼痛性转移性后脊椎体肿瘤的患者中，使用新开发的包含铰接式双极可扩展电极的脊柱肿瘤消融系统进行了经荧光透视或 CT 引导的靶向 RFA 治疗。这 26 名患者中包括 14 名女性和 12 名男性，年龄为 44-85 岁（平均年龄为 62 岁）。最常见的原发肿瘤为 7 名患者（27%）的肺癌和 5 名患者（19%）的肾细胞癌和肉瘤。其他肿瘤包括 2 名患者（8%）的乳腺癌和黑色素瘤以及 2 名患者（8%）的结肠癌、多发性骨髓瘤、神经内分泌肿瘤、头颈部鳞状细胞癌和 1 名患者（4%）的未知原发肿瘤。使用设备热电偶进行消融，可实时监测消融区域的周边，以确定消融范围。对患者进行了连续的术后疼痛评分。13 名患者接受了随访影像学检查，1 名患者接受了治疗区域的后续活检。采用配对双尾学生 t 检验评估术后 1 周和 1 个月时疼痛视觉模拟量表评分的统计学意义。
26 名患者中有 4 名在消融后出现短暂的神经根症状，经椎间孔阻滞缓解。手术过程中未发生永久性神经损伤。术中影像学显示，铰接式双极仪器可通过经椎弓根入路进入后脊椎体肿瘤。消融后影像学证实消融区域内有坏死。3 名患者在随访时发现治疗水平的疾病进展。为进行这些手术，未中断全身治疗。
新开发的铰接式设备靶向 RFA 治疗疼痛性后脊椎体转移性肿瘤既可行又安全。
